HC and Insurance Operations Analyst

NTT DATA Services•Lincoln, NE

3d•Remote

About The Position

The Claims Case Manager provides comprehensive claim servicing to insurance policyholders and manages claims from intake through final decision. The role includes reviewing medical documents, claim forms, and policy notes; keeping claimants updated through their preferred communication channels; and communicating with empathy and attention to detail. The position also involves calculating benefits, processing payments, maintaining accurate claim records, and analyzing data to identify trends and root causes. The employee must live in the continental United States and work remotely from a dedicated, quiet, professional workspace that meets the specified technology and connectivity requirements. NTT DATA provides a computer and headset; employees must provide high-speed internet of at least 50 Mbps and use a hard-wired Ethernet connection. A working personal device, such as a cell phone or tablet, is required for two-factor authentication. The scheduled availability window is Monday through Friday, 7:00 a.m. to 7:00 p.m. Central Time. Evening and Saturday overtime may be required based on business needs, particularly from November through February. The role pays $26 per hour. State-specific certifications related to the duties will be sponsored by the company, and successful completion of the certification program is desired. A drug screen and background check, including education and employment verification, are required.

Requirements

At least 2 years of experience in an analytical role reviewing medical benefits and claims.
At least 2 years of claims adjudication experience, preferably involving life and supplemental products such as coverage for cancer, stroke, heart attack, or kidney disease.
At least 4 years of experience reviewing and assessing medical records.
Experience articulating claim requirements clearly and concisely.
At least a high school diploma or GED.
At least 1 year of work-from-home experience with demonstrated productivity and quality.
A designated quiet area for completing calls.
Must live in the continental United States.
Must have a working personal device, such as a cell phone or tablet, for two-factor authentication.
Must provide high-speed internet of at least 50 Mbps and use a hard-wired Ethernet connection; Wi-Fi, mobile, wireless, public, or out-of-home connections are not permitted.
Must maintain a dedicated, permanent, professional workspace with minimal distractions and work consistently from the same location unless prior approval is obtained.
Must pass a drug screen and background check, including education and employment verification.
Must be available Monday through Friday between 7:00 a.m. and 7:00 p.m. Central Time; evening and Saturday overtime may be required based on business needs.

Nice To Haves

A college degree is preferred.
Successful completion of a company-sponsored state-specific certification program related to the job duties is desired.
Claims adjudication experience with life and supplemental products is preferred.

Responsibilities

Manage each claim from intake through the final decision.
Gather information and initiate claims through various channels.
Provide frequent claim status updates through claimants’ preferred communication channels.
Review medical documents, claim forms, policy notes, and medical records.
Log and update relevant information throughout the claim lifecycle and maintain accurate records and reports.
Communicate required medical records and claim information by email, mail, and phone.
Follow up on pending claims and help gather required medical records.
Calculate benefit amounts and process payments through the claims system.
Manage a caseload of active claims and complete end-to-end claim tasks.
Ensure accuracy and organization in logging, tracking, and reviewing claims, and flag potential fraudulent activity.
Compile and analyze data to identify trends and perform root cause analysis.
Collaborate with team members and management to address service issues and concerns.
Communicate with claimants empathetically and helpfully.